Provider Demographics
NPI:1588743314
Name:BALL, PATRICK ANDREW (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANDREW
Last Name:BALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7736 AIRWAYS BLVD.
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5306
Practice Address - Country:US
Practice Address - Phone:662-772-5222
Practice Address - Fax:662-772-5957
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18011207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02229397Medicaid
MSI13126Medicare UPIN
MS02229397Medicaid
MS02229397Medicaid